Form D-400x - Amended Individual Income Tax Return - 2014
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3D-400X
Web
Amended Individual
12-14
Income Tax Return 2014
Print in Black or Blue Ink Only. No Pencil or Red Ink.
For calendar year 2014, or fiscal year beginning
and ending
1 4
(MM-DD)
(MM-DD-YY)
Your Social Security Number
Spouse’s Social Security Number
You must enter your
social security number(s)
Your First Name
(USE CAPITAL LETTERS FOR YOUR NAME AND ADDRESS)
M.I.
Your Last Name
If a Joint Return, Spouse’s First Name
M.I.
Spouse’s Last Name
Mailing Address
Apartment Number
City
State
Zip Code
County
Country (If not U.S.)
(Enter first five letters)
Deceased Taxpayer Information
Reason for Amending Your Return
(Fill in the circle for all applicable boxes; see instructions)
Federal audit change
Fill in circle if return is filed and
signed by Executor, Administrator
Additional Income
(Include W-2. 1099, or K-1)
or Court-Appointed Personal
Adjustments to D-400 Schedule S
(Attach Schedule S & any required attachments)
Representative.
Tax Credits
(Attach Form D-400TC)
Filing Status
Taxpayer
(MM-DD-YY)
Change in Social Security Number or ITIN (SSN or ITIN on original return _____-_____-_______ )
Original return has been previously audited by the Department
Net operating loss
Spouse
(Include copy of your federal form 1045, including Schedules A & B)
(MM-DD-YY)
Injured/innocent spouse
Other
Important
You must complete the entire form including the explanation
Enter date of death of a deceased
taxpayer or deceased spouse.
of changes section on Page 3.
Were you a resident of N.C. for the entire year of 2014?
Yes
No
Residency
If No, complete Lines 1 through 12. Then go to Part D of Schedule
Status
Was your spouse a resident for the entire year?
S. Fill in residency information and complete Lines 20 through 22.
Yes
No
Filing Status
Fill in one circle only. (See instructions on Page 8)
IMPORTANT: Do not send a photocopy of this form.
1.
Single
2.
Married Filing Jointly
Name
(Enter your spouse’s
3.
Married Filing Separately
full name and Social
Security Number)
SSN
4.
Head of Household
5.
Qualifying Widow(er) with Dependent Child
)
(Year spouse died:
Enter Whole U.S. Dollars Only
6. Federal adjusted gross income
,
,
.
6.
(Form 1040, Line 37; Form 1040A, Line 21; or Form
00
1040EZ, Line 4) (If negative, see the Line instructions)
If amount
on Line 6, 8,
7. Additions to federal adjusted gross income
,
,
.
10, or 12 is
(From Part A of Form D-400 Schedule S, Line 4;
7.
00
negative, fill in
attach Schedule S if additions are reported.)
circle.
,
,
.
8. Add Lines 6 and 7
8.
Example:
00
9. Deductions from federal adjusted gross income
,
,
.
9.
(From Part B of Form D-400 Schedule S, Line 12;
00
attach Schedule S if deductions are reported.)
,
,
.
10. Subtract Line 9 from Line 8
10.
00
11. N.C. standard deduction OR itemized deductions (See instructions on Page 8)
,
,
.
If itemizing, complete Part C of Form
11.
00
If you claimed the standard
D-400 Schedule S and enter the amount
deduction on federal
from Line 19; attach Schedule S.
form 1040, fill in circle
,
,
.
12.
12.
Subtract Line 11 from Line 10
00
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